A Primer on Using Medicaid for People Experiencing Chronic Homelessness and Tenants in Permanent Supportive Housing. 5. Defining Medicaid Benefits and Services


This chapter describes the many services that Medicaid can cover to address the health and behavioral health care needs of people experiencing chronic homelessness and those living in PSH. These Medicaid-reimbursed health care and supportive services help people with disabling health conditions, including those who have experienced chronic homelessness, to recover and to live in community settings. Many states use Medicaid benefits to provide health care and some of the supportive services that help vulnerable people get and keep housing. With housing and supports, this population is able to avoid or change very costly patterns of service utilization, including frequent and avoidable emergency room visits, hospitalizations, and stays in nursing homes, detox facilities, or other types of inpatient or institutional care.

Because Medicaid is implemented through partnerships between states and the Federal Government, every state's Medicaid program is different. Within the definitions and guidelines provided by federal law and CMS, states have substantial flexibility in determining which optional Medicaid services to cover, and in defining Medicaid-covered services in state Medicaid plans and programs. This flexibility results in much variability among states in the approaches they have taken to defining the covered services that are available to people who experience homelessness or live in PSH. This chapter takes a closer look at some of the Medicaid benefits and services that some states have defined in ways that make it possible to cover some of the services provided in PSH or in other settings for people experiencing chronic homelessness, assuming those beneficiaries meet applicable criteria for medical necessity or service eligibility. Benefits and services potentially covered include FQHC services, rehabilitative services, case management services, and HCBS. The chapter stresses the importance of including in covered activities the supports that provide the "glue" that holds it all together for clients with complex needs--collateral contacts, case consultation, and multi-disciplinary team conferencing and interactions.

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